Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting.

OBJECTIVES: The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol. DESIGN: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews). RESULTS: Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants. CONCLUSIONS: The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.

Use of the Behaviour Change Wheel to design an intervention to improve the provision of mental wellbeing support within the audiology setting.

OBJECTIVE: This study describes the development of an intervention to increase the frequency of audiologists' asking about and providing information regarding mental wellbeing within adult audiology services. DESIGN: The Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed. RESULTS: A multifaceted intervention was developed to change audiologists' behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing, (2) providing general information on the mental wellbeing impacts of hearing loss, and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources. CONCLUSION: This study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work.

Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model.

OBJECTIVE: To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being. DESIGN: A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change). STUDY SAMPLE: Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3). RESULTS: Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss. CONCLUSION: Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Barriers and facilitators to asking adults with hearing loss about their emotional and psychological well-being: a COM-B analysis.

OBJECTIVE: To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being. DESIGN: This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model. STUDY SAMPLE: Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated. RESULTS: Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice. CONCLUSIONS: Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being.

A comparison of seasonal influenza and novel Covid-19 vaccine intentions: A cross-sectional survey of vaccine hesitant adults in England during the 2020 pandemic.

We compared intention to receive the seasonal influenza vaccine with a prospective coronavirus (COVID-19) vaccine among undecided or COVID-19 vaccine hesitant individuals to better understand the underlying differences and similarities in factors associated with vaccine intention. We delivered a cross-sectional online survey in October-November 2020. We included psychological constructs and sociodemographic variables informed by theory. We conducted pairwise comparisons and multiple linear regression models to explore associations between vaccine intention and psychological constructs. We recruited 1,660 participants, where 47.6% responded that they would likely receive the influenza vaccine, 31.0% that they would probably not accept the vaccination and 21.4% were unsure. In relation to the prospective COVID-19 vaccine, 39.0% responded that they would likely receive the vaccination, 23.7% that they would probably not accept the vaccination and 37.3% were unsure. Unique factors positively associated with COVID-19 vaccine intention were: perceived knowledge sufficiency about vaccine safety, beliefs about vaccine safety, and living in an area of low deprivation. The only unique factor positively associated with influenza intention was past influenza behavior. The strongest common predictors positively associated with intention were: favorable vaccine attitudes, the anticipated regret they may feel following infection if they were not to receive a vaccine, and the expectation from family or friends to accept the vaccine. Despite overall similarities in those factors associated with vaccination intention, we identified unique influences on intention. This additional insight will help support the planning and tailoring of future immunizations programmes for the respective viruses.

Factors associated with vaccine intention in adults living in England who either did not want or had not yet decided to be vaccinated against COVID-19.

Early studies showed that 28-36% of UK adults were unsure or unwilling to be vaccinated against COVID-19. We wanted to identify which socio-demographic, socio-economic, personal health and psychological factors were associated with COVID-19 vaccine intentions (CVI) in adults living in England who did not want, yet to consider, or not sure whether to vaccinate. In October/November 2020, prior to vaccine availability, we surveyed adults stratified by gender, region, and deprivation, with additional purposive sampling of those aged 50 and over and those from an ethnic minority. Two hundred and ten did not want; 407 had yet to consider; and 1,043 were not sure whether to be vaccinated. Factors positively associated with CVI were: favorable vaccine views, trust in institutions associated with vaccine approval, vaccine subjective norms, anticipated regret of not having a vaccine, perceived vaccine benefits, perceived safety knowledge sufficiency, and a history of having an influenza vaccine. Factors negatively associated were: anti-lockdown views, and being a health or social care worker. Whilst showing significant relationships with CVI when analyzed in isolation, neighborhood deprivation and ethnicity did show an independent relationship to intention when all study measures were controlled for. Our findings suggest vaccine promotion focusing on the anticipated regret of not having a vaccine, the benefits of a mass COVID-19 immunization program, and the safety of a vaccine whilst ensuring or engendering trust in those bodies that brand a campaign may be most supportive of COVID-19 vaccine uptake.

How Do Audiologists Respond to Emotional and Psychological Concerns Raised in the Audiology Setting? Three Case Vignettes.

OBJECTIVES: Emotional and psychological well-being are essential to overall health, but there is little research showing how to approach emotional and psychological concerns in the audiological setting. This study investigated audiologists' self-reported clinical behaviors in response to emotional and psychological concerns and/or symptoms raised by audiology clients. DESIGN: A sample of 83 Australia-based audiologists completed a survey including vignettes presenting older adults with hearing loss and experiencing symptoms consistent with either depression or grief. Content analysis was used to explore: (1) audiologists' self-reported usual response when clients present with emotional and psychological concerns and/or symptoms in the audiological setting; (2) audiologists' ability to identify and describe psychological symptoms; and (3) audiologists' self-reported clinical behaviors relating to client referral for psychological support. RESULTS: When asked to describe their usual clinical course of action in response to the vignettes, over one half the audiologists described actions that address the clients concerns related to psychological well-being. Where audiologists described how they would provide psychological support, they described modifications to the audiological rehabilitation program including involving significant others in the rehabilitation process, recommending additional support outside of the audiology setting (such as General Practitioner or psychologists), and providing emotional support and counseling. When prompted, the majority of participants recognized the two cases with depression as having a mental health condition; however, 48% of participants indicated the control case as also having a mental health condition. When asked directly, the majority of audiologists indicated that they would refer the three vignettes for specialist support; however, less than one third described referral to a General Practitioner and less than 5% described referral to a mental health professional as their normal course of action in the open response item. Twenty-five different professions/people were reported as potential sources for referral. CONCLUSION: These findings support the need for further training and/or resources for audiologists to enable them to appropriately detect, describe and refer for emotional and psychological concerns and/or symptoms raised by clients' in the audiology setting.

Knowledge, Beliefs, and Practices of Australian Audiologists in Addressing the Mental Health Needs of Adults With Hearing Loss.

Purpose Emotional and mental health is essential to overall health, but there has been little research on how to approach emotional and mental health in the audiology setting. This study provides a preliminary investigation into the current knowledge, beliefs, and practices of Australian audiologists in addressing the emotional and mental health needs of adults with hearing loss. Method A 22-item survey using open- and closed-ended questions was completed by 95 Australian audiologists using a cross-sectional study design. Results Two thirds of audiologists described being underconfident and lacking the skills required to provide emotional support to people with hearing loss. Barriers to delivering emotional support included feeling out of their depth (56.6%), time/caseload pressures (55.3%), and the perception that the provision of emotional support was not within an audiologist's scope of practice (31.6%). Audiologists described a desire to refer clients to mental health professionals yet highlighted significant barriers, including not knowing who to refer to (54.7%), when to make a referral (49.3%), or how to make a referral (38.6%). Audiologists overwhelmingly (96%) indicated that they would like to develop their knowledge and skills associated with the provision of emotional and mental health support in the audiological setting. Conclusion Knowledge, skills, and time were identified as the key areas that require attention in order to allow audiologists to address the emotional and mental health needs of adults with hearing loss.

Hear-Communicate-Remember: Feasibility of delivering an integrated intervention for family caregivers of people with dementia and hearing impairment via telehealth.

PURPOSE: To evaluate the feasibility of Hear-Communicate-Remember, a training programme developed for family caregivers of people with dementia and hearing impairment that integrated hearing, communication and memory strategies, which was intended to be delivered via telehealth. MATERIALS AND METHODS: Participants included six dyads consisting of adults with dementia and hearing impairment and their family caregivers. Data collection involved a combination of semi-structured interviews, self-report questionnaires and field notes. RESULTS: Analysis of the qualitative interviews revealed four themes: appropriateness of intervention resources, considerations for the delivery of intervention via telehealth, knowledge and application of intervention strategies, and impact of the intervention on day-to-day life. Results from the satisfaction survey indicated that caregiver participants were mostly satisfied with all aspects of the intervention except the use of some technological components. The field notes described challenges with implementation via telehealth. CONCLUSIONS: Future research involving a cohort comparison study with a larger cohort of dyads is needed to establish treatment efficacy.

How do Hearing Aid Owners Acquire Hearing Aid Management Skills?

BACKGROUND: Clinical studies have found up to 90% of hearing aid owners demonstrate difficulty with basic hearing aid management tasks and almost 50% of hearing aid owners self-report not receiving enough practical help from their clinician regarding how to use their hearing aid. Although studies have highlighted the overwhelming amount of information and training required to learn how to use a hearing aid appropriately, a gap remains in the literature regarding the range of methods by which hearing aid owners acquire the knowledge and skills for hearing aid use, and whether these approaches are considered beneficial. PURPOSE: To gain insight into how both hearing aid owners and hearing health clinicians view the acquisition of hearing aid management skills and the efficacy of currently used methods of hearing aid training. RESEARCH DESIGN: Concept mapping techniques were used to identify key themes, wherein participants generated, sorted, and rated the importance of statements in response to the question "How do hearing aid owners learn the skills required to use, handle, manage, maintain, and care for their hearing aids?" STUDY SAMPLE: Twenty-four hearing aid owners (aged 56-91 years; 54.2% male) and 22 clinicians (aged 32-69 years; 9.1% male). DATA COLLECTION AND ANALYSIS: Participant perspectives were collected via group concept mapping sessions in October 2015. Hierarchical cluster analysis was used to identify themes and develop a framework for understanding how skill acquisition occurs. Participants rated each method of hearing aid skill acquisition as to how beneficial it was and how often it was used. RESULTS: Participants identified 75 unique items describing how hearing aid management skills are acquired within six concepts: (1) Relationship with the clinician, (2) clinician as a source of knowledge and support, (3) hands-on experience, (4) seeking additional information, (5) asking support people for help, and (6) external resources. CONCLUSIONS: The results of this study highlight the diverse methods and sources by which hearing aid owners learn the skills necessary to use, manage, and maintain their hearing aids. Significant emphasis was placed on the role of the hearing health clinician to provide training, support, and an ongoing professional relationship, with lesser roles played by family, friends, and other health professionals.

Factors Associated With Self-Reported Hearing Aid Management Skills and Knowledge.

PURPOSE: Hearing aid management describes the skills and knowledge required for the handling, use, care, and maintenance of the hearing aid. The importance of hearing aid management skills and knowledge is evidenced by their association with hearing aid outcomes. However, the nature of this association and the influence of participant factors on this association are unknown. Accordingly, the aims of the current study were to (a) investigate participant factors that influence hearing aid management skills and knowledge and (b) investigate the impact of hearing aid management skills and knowledge on hearing aid outcomes. METHOD: Factors associated with hearing aid management skills and knowledge were investigated through an e-mail- and paper-based self-report survey, including the Hearing Aid Skills and Knowledge Inventory (Bennett, Meyer, Eikelboom, & Atlas, 2018b) and the International Outcomes Inventory for Hearing Aids (Cox & Alexander, 2002). The study sample included 518 adult hearing aid owners, ranging in age from 18 to 97 years (M = 71 years, SD = 14 years), 61% male and 39% female, recruited from seven hearing clinics across Australia. RESULTS: Participant factors found to be associated with hearing aid skills and knowledge included participants' age, gender, style of hearing aid, age of current hearing aid, and total years of hearing aid ownership. Higher levels of hearing aid management skills and knowledge were found to be associated with better hearing aid outcomes, specifically higher self-reported satisfaction with hearing aids, perceived benefit from hearing aids, and overall outcome of the hearing aid fitting as evaluated by the International Outcomes Inventory for Hearing Aids. CONCLUSIONS: Hearing aid management difficulties were greatest for older people, women, and owners of behind-the-ear style of hearing aids, suggesting that clinicians need to be cognizant of the additional needs for these three groups. The positive association between hearing aid outcomes and hearing aid skills and knowledge emphasizes the importance of education and training on hearing aid management for successful aural rehabilitation.

Evaluating Hearing Aid Management: Development of the Hearing Aid Skills and Knowledge Inventory (HASKI).

PURPOSE: Although hearing health care clinicians provide training on hearing aid handling and management as part of the rehabilitation program, clinical studies suggest that the level of management skill demonstrated by hearing aid owners is low. In the absence of a comprehensive clinical survey to identify these shortfalls in clinical training, the objective of this study was to develop and report the psychometric properties of the Hearing Aid Skills and Knowledge Inventory (HASKI: a self-administered version and a clinician-administered version). The HASKI evaluates the knowledge and skills required for hearing aid management. A secondary aim was to report the prevalence of hearing aid management difficulties in an Australian population. METHOD: The development of the HASKI and the investigation of its psychometric properties in a prospective convenience cohort of 518 adult hearing aid owners, ranging in age from 18 to 97 years (M = 71 years, SD = 14), 60% male, 38% female, and 2% undisclosed, recruited from 7 hearing clinics across Australia, were used. RESULTS: The HASKI (both the self-administered and clinician administered) demonstrated high internal consistency, interdimensional relationships, construct validity, test-retest reliability, interobserver reliability, and criterion validity. A range of aptitudes were observed from low to full competency, with 99% of participants indicating difficulty with at least 1 item on the survey. CONCLUSIONS: The Hearing Aid Skills and Knowledge Inventories are valid and reliable measures of hearing aid handling and management skills with good potential for use in clinical settings. Hearing aid management is an area of difficulty for the majority of hearing aid owners, indicating the need for clinicians to improve the efficacy of hearing aid management training delivered.

Investigating the Knowledge, Skills, and Tasks Required for Hearing Aid Management: Perspectives of Clinicians and Hearing Aid Owners.

PURPOSE: The purpose of this study is to identify hearing aid owners' and clinicians' opinions of the knowledge, skills, and tasks required for hearing aid management and the importance of each of these to overall success with hearing aids. METHOD: Concept mapping techniques were used to identify key themes, wherein participants generated, sorted, and rated the importance of statements in response to the question "What must hearing aid owners do in order to use, handle, manage, maintain, and care for their hearing aids?" Twenty-four hearing aid owners (56 to 91 years of age; 54.2% men, 45.8% women) and 22 clinicians (32 to 69 years of age; 9.1% men, 90.9% women) participated. RESULT: Participants identified 111 unique items describing hearing aid management within 6 concepts: (a) "Daily Hearing Aid Use," (b) "Hearing Aid Maintenance and Repairs," (c) "Learning to Come to Terms with Hearing Aids," (d) "Communication Strategies," (e) "Working With Your Clinician," and (f) "Advanced Hearing Aid Knowledge." Clinicians' opinions of the importance of each statement varied only slightly from the opinions of the hearing aid owner group. Hearing aid owners indicated that all 6 concepts were of similar importance, whereas clinicians indicated that the concept "Advanced Hearing Aid Knowledge" was significantly less important than the other 5 concepts. CONCLUSION: The results highlight the magnitude of information and skill required to optimally manage hearing aids. Clinical recommendations are made to improve hearing aid handling education and skill acquisition.

Exploring Hearing Aid Problems: Perspectives of Hearing Aid Owners and Clinicians.

OBJECTIVES: To gather perspectives of hearing aid owners and hearing healthcare clinicians with regard to problems that arise after hearing aid fitting and use these perspectives to generate a conceptual framework to gain a better understanding of these problems. DESIGN: Participants included a group of 17 hearing aid owners and a group of 21 hearing healthcare clinicians; data collection occurred separately for each group. Participants each attended two group sessions in Perth, Western Australia, wherein they: (1) generated statements describing the problems associated with hearing aids and (2) grouped and rated the statements to identify key themes. Concept mapping was used to generate a conceptual framework. RESULTS: Participants identified four concepts regarding hearing aid problems as follows: (1) hearing aid management; (2) hearing aid sound quality and performance; (3) feelings, thoughts, and behaviors; and (4) information and training. While hearing aid owners and clinicians generated similar results regarding the concepts derived, the clinicians reported that the problems identified had a greater negative impact on hearing aid success than did hearing aid owners. CONCLUSIONS: The magnitude and diversity of hearing aid problems identified in this study highlight the ongoing challenges that hearing aid owners face and suggest that current processes for hearing aid fitting can be improved. Problems relating to hearing aid management were most often deemed to have the greatest impact on hearing aid success and be the most preventable/solvable, and thus are a good starting point when addressing hearing aid-related problems.

Kinematic investigation of lingual movement in words of increasing length in acquired apraxia of speech.

The current study aimed to use electromagnetic articulography (EMA) to investigate the effect of increasing word length on lingual kinematics in acquired apraxia of speech (AOS). Tongue-tip and tongue-back movement was recorded for five speakers with AOS and a concomitant aphasia (mean age = 53.6 years; SD = 12.60) during target consonant production (i.e. /t, s, k/ singletons; /kl, sk/ clusters), for one and two syllable stimuli. The results obtained for each of the participants with AOS were individually compared to those obtained by a control group (n = 12; mean age = 52.08 years; SD = 12.52). Results indicated that the participants with AOS exhibited longer movement durations and, in some instances, larger tongue movements during consonant singletons and consonant cluster constituents embedded within mono- and multisyllabic utterances. Despite this, two participants with AOS exhibited a word length effect that was comparable with the control speakers, and possibly indicative of an intact phonological system.

Kinematic analysis of articulatory coupling in acquired apraxia of speech post-stroke.

PRIMARY OBJECTIVE: Electromagnetic articulography was employed to investigate the strength of articulatory coupling and hence the degree of functional movement independence between individual articulators in apraxia of speech (AOS). METHODS AND PROCEDURES: Tongue-tip, tongue-back and jaw movement was recorded from five speakers with AOS and a concomitant aphasia (M = 53.6 years; SD = 12.60) during /ta, sa, la, ka/ syllable repetitions, spoken at typical and fast rates of speech. Covariance values were calculated for each articulatory pair to gauge the strength of articulatory coupling. The results obtained for each of the participants with AOS were individually compared to those obtained by a control group (n = 12; M = 52.08 years; SD = 12.52). Comparisons were made between the typical rate productions of the control group and the typical and fast rate productions of the participants with AOS. MAIN OUTCOMES AND RESULTS: In comparison to the control group, four speakers with AOS exhibited significantly stronger articulatory coupling for alveolar and/or velar speech targets, during typical and/or fast rate conditions, suggesting decreased functional movement independence. CONCLUSIONS: The reduction in functional movement independence might have reflected an attempt to simplify articulatory control or a decrease in the ability to differentially control distinct articulatory regions.